Switching and Combining Biologics for the Treatment of Severe Asthma

There are 5 biologic medications currently approved for the treatment of severe asthma

This article is part of MPR‘s coverage of the American Thoracic Society International Conference, taking place in Dallas, Texas. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from ATS 2019.

DALLAS – Without any head-to-head data or algorithms on the optimum method of choosing between the newly introduced biologics for the treatment of severe asthma, clinicians must observe patient clinical response after adequate trial periods, and then make changes as necessary, according to research presented at the American Thoracic Society’s International Conference, held May 17 to 22, in Dallas, Texas.

Severe asthma is defined as asthma that is uncontrolled despite high doses of inhaled corticosteroids (ICS) and a long-acting beta agonist (LABA) or other systemic steroids or controller medications. There are 5 biologic medications currently approved for the treatment of severe asthma that have been demonstrated to reduce exacerbations and increase lung function. The current study was designed to examine the prescribing patterns at a large academic teaching center to identify patients who have taken more than one biologic asthma medication, either sequentially or simultaneously, and to analyze the outcomes.

For the study, 6 patients were identified. All were at least on high-dose ICS/LABA combination inhalers, 4 of the 6 were also on Spiriva, and 3 of the 6 were on chronic systemic glucocorticoids. Of the patients, 3 with persistent symptoms were switched from omalizumab to mepolizumab, and 1 patient was started on mepolizumab while continuing on omalizumab for frequent exacerbations and persistent symptoms. One patient was switched from mepolizumab to omalizumab for a lack of improvement in symptoms, and another was switched to reslizumab from mepolizumab for persistent eosinophilia. Overall, the addition of or change to a biologic led to Asthma Control Test score improvements for 1 of the 6 patients, spirometry improvements for 2 patients, symptom improvement for 2 patients, decreased rescue inhaler use for 1 patient, and decreased exacerbation frequency for 1 patient. No adverse reactions were observed.

Investigators conclude that when it comes to treating severe, refractory asthma with these new biologics, “adequate trial periods of medication are necessary and appropriate changes can be safely implemented if there is no patient clinical response. As larger cohorts are examined, it will be important to assess patient factors that may be able to guide clinicians in predicting patient response.”